Individual provider Active NPI

Mia Rose O'Mara, PA

  • Physician Assistant
  • Orlando, FL
National Provider Identifier
1538717806
Registry record updated Dec 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9112902 Issued in FL
Practice address
2868 S Alafaya TRL Ste 130
Orlando, FL 32828-7974
Phone
(407) 770-0063
Fax
(407) 770-0129
NPI assigned
Aug 29, 2019
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9112902 FL Primary

Addresses

Primary practice location

2868 S Alafaya TRL Ste 130
Orlando, FL 32828-7974

Mailing address

151 Southhall LN Ste 300
Maitland, FL 32751-7172
Phone (866) 400-3376

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200319000922 FL Practitioner - Physician Assistant 5092143321 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1410 W Broadway St
Suite 205
Oviedo, FL 32765-6472
Phone (407) 359-2100

1503 Buenos Aires Blvd
Suite 100
The Villages, FL 32159-6825
Phone (352) 753-2812

2868 S Alafaya TRL
Suite 130
Orlando, FL 32828-7974
Phone (407) 770-0063

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Leavitt Medical Associates of Florida Inc CurrentSince Apr 6, 2020 Accepting new patients
Leavitt Medical Associates of Florida Inc Past Accepting new patients

Locations

151 Southhall Ln
Ste 300
Maitland, FL 32751
Phone (407) 917-7293

2868 S Alafaya Trl
Ste 130
Orlando, FL 32828
Phone (407) 770-0063

725 W Granada Blvd
Ste 44
Ormond Beach, FL 32174
Phone (386) 898-0547

1410 W Broadway St
Ste 205
Oviedo, FL 32765
Phone (407) 359-2100

8 Office Park Dr
#A
Palm Coast, FL 32137
Phone (386) 445-6191

1720 Dunlawton Ave
Ste 2
Port Orange, FL 32127
Phone (386) 322-8310

1503 Buenos Aires Blvd
Ste 100
The Villages, FL 32159
Phone (352) 753-2812

Networks

  • Freedom Health HMO Network

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765756800000",
    "number": "1538717806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 SOUTHHALL LN STE 300",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517172",
            "telephone_number": "866-400-3376",
            "fax_number": "407-650-3455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2868 S ALAFAYA TRL STE 130",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328287974",
            "telephone_number": "407-770-0063",
            "fax_number": "407-770-0129"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'MARA",
        "first_name": "MIA",
        "middle_name": "ROSE",
        "credential": "PA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-08-29",
        "last_updated": "2025-12-15",
        "certification_date": "2025-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9112902",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.